Assessment of the efficacy of large volume delayed sampling primary culture and pathogen reduction in preventing septic reactions from platelet transfusions

BACKGROUND: Many mitigation processes have been introduced to reduce septic transfusion reactions (STRs) caused by the transfusion of bacterially contaminated PLTs. METHODS: The efficacy of primary culture and pathogen reduction is assessed in this review using data from long-term hemovigilance programs in the US, Canada, UK, France, Switzerland, and Australia. These surveillance programs are passive, with under-reporting of cases and differences in diagnostic criteria and reporting requirements between countries and institutions, but changes in rates over time reflect changes in the incidence of reported STRs. RESULTS: Prior to the introduction of these mitigation methods, reported STR rates ranged from 10 to 100 per million PLT units transfused. Reported STR rates were lowered following the introduction of primary culture using aerobic culture of 8-20 mL samples of PLT pools and apheresis collections around 24 h after collection, ranging from 2 to 24 per million PLT units. Use of large volume, delayed sampling (LVDS) primary culture of 16-20 mL, using both aerobic and anaerobic culture bottles, of pools and apheresis split units performed 36-48 h after collection was associated with a further decrease in reported STR rates, ranging from 0.56 to 4 per million PLT units transfused. Pathogen reduction of apheresis and whole-blood derived PLTs using amotosalen/UVA was associated with a low incidence of reported STR rates, ranging from 0 to 1.1 per million PLT units transfused. CONCLUSIONS: Reported STR rates using LVDS primary culture were lower than rates using other primary culture methods, with even lower rates using the amotosalen/UVA for pathogen reduction.